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My cataract updates

Hello all,
I returned home a day back after meeting the cataract doctor on monday.
I will post all the proceedings here so that it can be useful for others who has to go for cataract under high myopic + sjs + sjogrend + mgd + high photophobic eyes.

i had sjs in 1990 at age of 8 years.

Had preliminary check up with cornea specialist.who had seen me and had vision test also.Stats of vision are as follows.

Right eye:Finger counting vision upto 10-12feets.
Left eye:could read first line on vision test globe, without any power.With power of -10 spherical and -2 cylindrial added to it, i could read 4 lines.So thats my best corrected vision at present.

I had not worn any powered specs in my life.No doctor were able to see me properly due to non stabilized surface and excessive dryness.The coernea specialist was surprised at this and asked me to wear these numbers if i dont get cataract done shortly.

After these the cornea specialist saw me who had seen me before also in 1997 and 2011
He told my surface related issues have been improved over the years.And said such improvements are generally not seen in SJS patients.So i was doing good on that.(i would say thanks to cyclosporine).
He had me on schimer test and for left ye it was 12.So not bad.
He said my lids dont produce oils of the required quality.And said my lids are scratched.He said not to have any surgical procedure for lid smoothneing. as the more we have surgical procedues, the more weaker eye will get.He gave a lube to be applied on lids.its a Chlorocol contented eye ointment.

Then i visited the cataract specialist.He saw me and was ready to operate me.My cataract is Posterior Sub Capsular cataract.We asked him to oparate himself and not by his co ordinators.He said he will only operate and none else can operate such difficult cataracts.which is right and i agree to.

he scheduled my surgery on 6th march tuesday.I will be in for pre operative check ups on Monday.The things related to IOL selection would be done then only.

As myopic cataract needs to be watched closely for a higher chance of Retinal Detachment(RD), he advised me to take second opinion for retina.which will be done on monday evening.

Im on genteal eye drops, genteal eye ointment and cyclosprine 0.1% at present.Cataract doctor called up cornea doc to recheck if cyclosporine is okay in regards to infections.and cornea doc said he is okay with cyclosporine and no need to stop it.(this is an interesting debate whether cyclosprine increases chance for infection or not, i had a small discussion on this with our user Littlemermaid).I m going to continue with cyclosporine till 4th march.Then will stop it.

Hi
Went to the local doctor for general check ups and retina advise.
The doc told me not to have any other retina checkups unless the one which is scheduled 1 day prior to the surgery.
One imp thing i came to know as doc said retina cannot be checked as precisely in cataract patients as it can be in a clear IOL patients.The cloudiness of iol bars the vision behind the eye(where the retina is).

He told me very strictly to cancel the surgery even on last moment if i come to know Dr.Abhay Vasavada is not going to operate.Asked me to get operated only if Dr.Abhay Vasavada operates, not any other in his team.(even though Dr.Abhay has confirmed me that he will only operate we can never know if they change last minute due to unavailability etc)

i did not get a good chance to have a detailed talk to him.i just made him aware that i am an informed patient by asking him things about which technic he Will use in surgery. he confirmed he Will be doing phaco.he also informed me that new technology is invented just before three months where they use laser technology in operations.
i asked him to make sure all pre operative tests as m highly myopic.then only he advised to take second opinion about retina from another retina specialist,out of his clinic.(this is the benefit of patient having information )
i Will be having a few more queries when i meet him pre operative.

I think laser for cataract is available in India but not with him yet, is that right? Just wondering if he thinks it might help if capsule is fragile, I imagine the equipment's very expensive. Wish you both the very best xx

oh yes he didn't offer me laser surgery so i presumed thy don't have the facility yet.
m getting more confused whether i should wait for more time before surgery as to wait some more new inventions coming up.likes of laser,lacritin that enhances glands to produce more tears etc. also the doctor informed that they are going to have BSL Facility by October this year in their clinic.
it all confuses me more. i Will try to check his confidence when i meet him tomorrow.surgery is scheduled on Tuesday if all goes well within pre operative periods. if i feel his confidence is lacking then i may opt out temporarily and wait. my cataract does not need urgent treatment at present.

Wonderful innovations, and good to hear your cataract is not so urgent, you must be feeling much more relaxed about this. (Laser cataract surgery is advertised but often looks like spin-off from laser refraction business, doesn't it, as if they don't care about outcome, I hope the businesses would not take on a difficult case, so much better with hospital expertise.) I do feel with my daughter that the surgeon's expertise is the most reassuring along with resources available, although I suppose finer tools and technology make his job easier.

So happy you have the resources for relaxed choices after the court case and the opportunity to work with Dr V with your best interests at heart. Good to hear they are innovating with BSL in 7m. Would they use bandage lens for you post-op or is it entirely steroid control? I was wondering if he thought the capsule is more fragile than normal? And curious where he recommends for tied IOL for the other eye? I notice he says there's a high incidence of glaucoma post-IOL in aphakic eye and wonder whether he can look after you post-op if you go for that elsewhere?

hi.
i m not sure about using bandage lenses or steroids after surgery for wound healing.i Will ask him tomorrow.

the other eye is to be operated after this one gets done with.they Will have to use fixation iol because the capsule is raptured in that eye by a cataract is surgery in 2000 when there was no expert surgeon around as well as lack of technology.

dr.sangwan and dr.vasavada both were keen on operating my better eye first then the other eye.

hi all
had all the pre operative check up done yesterday.felt like my eye is being butchered again and again at every check up.

the case seems to be complicated not only from dry eye front.but many other complications are there.

i had retina checked at two different places.both said my retina is too thin .they say retina is thin from birth itself and its good that till now it did not have a hole or tear or detachment.
they both said thin retina is not a problem for cataract surgery.so both gave green signal for surgery.but told to be extra careful by checking retina often.
vision correction after cataract Will depend on how much the retina works.being thin it won't give me a normal eyes vision.so they did not have any idea how much correction of vision Will be done. sad.

after all the check ups they found my eye is.s too long.axis of eyes suggests i have myopia since birth.they found my myopic number to be -17!
the doctor said he has never seen such large myopia.so they sent me for check up again.the problem with taking corneal measurement was my eye was getting dry within a second of putting drop.they needed wet eyes to take measurement of it. they tried a lot and got success sometimes. but results were varying each time. but again they found myopia around same range they found before.

then had a counselling with doctors and he said he would not be able to put lenses as such large myopic power lenses is not available anywhen in the world.i was really disappointed.
then i had a talk with my local optho doctor.he talked to dr.vasavda and asked him to consider putting lenses of any power so as to protect weak retina.

then dr.v felt happy to have such informed patients.and he told he Will try to put lenses.the decision Will be taken after he opens my eye in operation theatre as he want to see whether capsule is strong enough or not.if he finds capsule is weak he Will refrain from putting a lenses and leave eye aphakik.as he said the cataract is matured and would need removal soon else it would melt and give vision loss which would be irreversible.

so i Will be undergoing cataract surgery in next four hours.i might not be able to be here immediately.lets see how things go . keeping fingers crossed .

hi all,
just wanted to convey that im alright , fitted with an IOl successfully.
But they are using pupil dialation drops to promote healin so im unable to read on pc.
I will write details later.
Thank u all for praying n wishing.
Im happy with the surgery for now.

So happy to hear he was able to fit and retain an IOL. Dearly hope you are comfortable. Just wondering what steroid he is maintaining the eye surface with? LM and I are so very happy for you and send you lots of love.

thank you
There are no steroids presctibed yet!
My current regim is
3x vigamox
2x pantanil(cant spell it properly..its diluting drops which keeps my pupil not able to focus at all.)
4x genteal eye drops
1x cyclosporine.

I think they will start fml next week or so.
Having an appointment on monday for post op check ups.
I have a ;ost of things to discuss but cant due to dilated pupil..not able to read at all..will post later

post 1 week surgery had a follow up check up on monday.
The test consisted of vision test and pressure check.
I could read 3 lines on standard vision chart.Third line seemed hard to read.
The pressure was normal.

They advised to continue pentolate medicine for another 1 week twice a day.Next monday they will taper it down to once per day for next 1 week.after stopping the pentolate i will get to know exactly how much vision and other improvements i get.pentolate stops eye from focusing.so still cannot read much.

the night vision has improved.also the depth and colours are clearly visible now.which i could not before.i had Alcon Restore monofocal iol implanted.

they still didnt prescribe any steroid contrl drops.the medication is as it is.

One point i would like to make is...i doubt i have keratoconus in my operated eye.I will have a detailed discussion about it in new thread.I need advise for modertors on some points.While taking corneal measurement, the doctor could not take measurements easily as eyes were getting dry within secords.Also another problem they faced was...everytime measurement was differing from previous figures.I heard them saying...sometimes measurement comes to 52-53 sometimes 48 or so...i dnt knw much about this but i think i have keratoconus as the size of cornea keeps varying.Right now im not thinking much about it as i want to concentrate on healing of the eye.

Well now im on taper off mode for pentolate eye drops.So i can read things better now.But still vision gets blurred again and again due to dilated pupil.
Im experiecing frequent vision differences due to all the factors pentolate, dry eyes, and eyes getting used to the new lense etc.

I will be off from pentolate this weekend.However i am and will be continuing vigamox antibiotic drops 3 times a day for some more time.

Im amazed not to be on fml/loteflam type steroid drops after surgery.My local eye doc saw me last week and he said he will prefer to start fml soon.But the doc who operated me, didnt put me on steroids and said cyclosporine drops is sufficient to lower the inflamation if any occurs.
Im following surgeons advise and not using steroid drops.

It will be another few weeks to get final outcome of the surgery in terms of vision.I shall need -4 / -5 glasses after surgery as the IOL was only available upto -5 range.

I will consider BSL after 2 months or so.will have a trial and see how it feels.

Hiren ~ This is great news, so happy for you. Are you using a tear substitute drop to keep the eye surface moist? (we are mostly using medical saline vials these days unless she feels the need of something more viscous)

Yes i have been using genteal eye drops...more frequently than what i used to do before surgery.about 4times d day.
Doctor had told me due to pentolate and antibiotic eye drops i will feel more dryness than before for time being which should relieve after stopping the medication.
So i need tear substitute frequently.

Also my cornea is sutured after surgical incision.The suture is non soluble.They may remove it after a month or so.Or may leave it if it does not create any problem for me.The cornea was healed properly on 1st day post operative.So not much to worry.

Also taking dietary supplements like multivitamin,fish oils, vitamin A and eating more fruits etc.

Also giving importance to eye lid care on advise of abbygirl here on this forum.

Hello all,
Im recovering!
Today went to local ohto doc as i did not get appointment of Dr.Vasavada for next week.I will visit him on 2nd april.

My local optho suggested me to start loteflam/fml now for a few weeks.So i m starting it from today.
Also tapering off Pantolate , will instill on alternate days for 1 more week.then off from it.

Had vision test...my current vision is 20/70 and with a device with very small hole my vision was upto 20/50.So i will be able to get 20/50 with glasses/lenses for sure.Not bad...

Before surgery could not read even 1st line on vision actuity test board.

Doctor told me im having congestion on cornea due to sutures right near the sutures place.So he advised to get it removed at Dr.Vasavadas clinic when we meet him.
Otherwise all seems okay...My new schedule will be
3x genteal
2x vigamox
1xloteflam

HI all,
Its been more than 3 weeks since the date of surgery.The eye is getting whiter now.

The positive changes i m seeing are
Better night vision(if i compare to the vision prior to the surgery i wonder why did i take so long to decide for this surgery!)
Over all vision and sharpness has improved a lot.Im seeing most of the things much better compared to what i was seeing earlier.
Distance vision has improved.That is helping me in 2 wheeler driving.

Having an appointment on monday with dr.vasavada.He would be seeing me 1st time after the surgery.

Hi all,
I had a follow up check up with the surgeon yesterday.
Things seems to be okay.
Suture was removed yesterday as everything looks fine at present.
Retina checkup was also okay.Before surgery they found my myopic numbers to be around -16, and after putting iol of -5, now my eyes additional power needed is -3 for far and +4.5 for reading.which gives me the vision of 6/24.

Vision test was performed where i could read 4 lines.means 6/24 was the vision acuity.
There will be some changes in vision after suture removal so still no final glasses prescribed.

Surgery front, everything is and done.However will have to keep checking retina every 1/2 months for next 6 months and then every 6 months.

Overall im happy with it.6/60 to 6/24 is a wonderful journey.I will post my final prescription in a couple of weeks time.